Patellar clamping instrument

ABSTRACT

A patellar clamp and associated system and method for using the clamp are provided. A patellar clamp includes a pair of handles movably coupled together, a patella support portion connected to the pair of handles and configured to engage a first side of a patella, and a reamer guide configured to engage a second side of the patella. The patella support portion and the reamer guide each include a first pair of flanges configured to engage a first and second tendon associated with the patella. The reamer guide is configured to allow reaming and resurfacing the entire desired posterior articular surface of the patella in a single operation without readjusting the position of the reamer guide.

PRIORITY CLAIM

This application claims priority U.S. patent application Ser. No.15/180,047, filed Jun. 12, 2016, which issued as U.S. Pat. No. 9,737,317on Aug. 22, 2017; U.S. patent application Ser. No. 13/918,429, filedJun. 14, 2013, which issued as U.S. Pat. No. 9,364,245 on Jun. 14, 2016,the entirety of which is incorporated herein by reference, and to U.S.Provisional Patent Application No. 61/660,250, filed Jun. 15, 2012, theentirety of which is herein incorporated by reference.

BACKGROUND OF THE DISCLOSURE

The present disclosure generally relates to surgical instruments, andmore particularly to an instrument and associated method for clampingthe patella during a surgical procedure.

Surgical joint repair and replacement involving the knee includesresurfacing and preparing the posterior articular surface of the patella(knee cap) to accept a prosthetic patellar implant. FIG. 1 shows thetypical anatomy of a knee. In some cases, resurfacing of this bone isaccomplished by milling or planing the surface of the patella using apowered reamer having cutting teeth. During the surgical procedure, thepatella is everted involving rotating and inverting the patella byapproximately 45-180 degrees to gain access to the posterior surface forreaming and resurfacing.

A patellar clamp is used to hold the patella in the everted position forreaming. The anterior and posterior surfaces of the patella are clampedbetween a lower fixed platform and an upper adjustable reamer guidewhich can be varied in distance from the platform to accommodate thethickness of the patella. The reamer guide is generally tubular shapedand functions to rotatably confine the reamer therein during themilling/planing procedure. For stable support of the reamer guide andpatella during reaming, the bottom annular edge of the guide generallyincludes sharp and pointed teeth for gripping the posterior articularsurface of the patella to be resurfaced. The teeth also resist twistingof the patella during reaming.

The foregoing arrangement, however, restricts the amount of patellarsurface area that is available for reaming which is not occupied byengagement with the bottom edge of the guide and teeth. Sufficientpurchase should be available on the patella to engage the guide teethfor reaming stability, resulting in the use of a reamer guide smaller indiameter than ideal and thereby further restricting the surface area ofthe patella available for reaming. This may result in un-resurfaced bonearound the periphery of the patella. Often, the surgeon must thereforereposition the reamer clamp and reamer to access the outer regions ofthe patella posterior articular surface. This causes the teeth on thereamer guide to sometimes engage portions of the quadriceps and patellartendons when clamped to the patella, which causes trauma to the tendons.

SUMMARY OF THE DISCLOSURE

A patellar clamp and associated system and method for using the clampare provided. In some embodiments, a patellar clamp comprises a pair ofhandles movably coupled together, a patella support portion operativelyconnected to the pair of handles and configured to engage a first sideof a patella, and a reamer guide configured to engage a second side ofthe patella. The patella support portion and the reamer guide eachinclude a first pair of flanges configured to engage a first and secondtendon associated with the patella. The reamer guide is configured toallow reaming and resurfacing a predetermined portion of an articularsurface of the patella in a single operation without readjusting theposition of the reamer guide.

In some embodiments, a method of clamping a patella is provided. Themethod includes selecting, from a plurality of reamer guides, a reamerguide configured to enable reaming a predetermined portion of a patellarsurface. The selected reamer guide is configured with a first pair offlanges extending from the reamer guide. The method also includesattaching the selected reamer guide to a patellar clamp including a pairof handles and a bottom clamping arm with a patellar support portion anda second pair of flanges. The method includes placing the patellar clampin an open position, positioning an everted and rotated patella betweenthe selected and attached reamer guide and the patellar support portionof the bottom clamping arm, and squeezing the pair of handles togetherin a closing motion, causing the selected and attached reamer guide tolower toward the patella and the first pair of flanges and the secondpair of flanges to operably engage the quadriceps tendon and patellartendon.

In some embodiments, a system for clamping a patella is provided. Thesystem includes a patellar clamp comprising a pair of handles movablycoupled together, a patella support portion operatively connected to thepair of handles via a bottom clamping arm and configured to engage afirst side of a patella, the patella support portion including a firstpair of flanges each configured to engage a first and second tendonassociated with the patella and a plurality of reamer guides, eachreamer guide of said plurality having a different diameter than eachother reamer guide of said plurality to allow a user to select anappropriately-sized reamer guide, wherein each reamer guide isconfigured to engage a second side of the patella, each reamer guideincluding a second pair of flanges configured to engage said first andsecond tendons associated with the patella.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a cutaway view of the typical anatomy of the knee.

FIG. 2 is an isometric view of a patellar clamp in accordance with someembodiments of the present disclosure.

FIG. 3 is an isometric view of a patellar clamp with the reamer guideremoved in accordance with some embodiments of the present disclosure.

FIGS. 4A, 4B, and 4C are front, side, and bottom profile views of apatellar clamp in accordance with some embodiments of the presentdisclosure.

FIG. 5 is a cross-sectional side view of the patellar clamp inaccordance with some embodiments of the present disclosure taken alongline A-A of FIG. 4.

FIGS. 6A, 6B, and 6C are side, top, and rear profile views,respectively, of a bottom clamping arm of the patellar clamp inaccordance with some embodiments of the present disclosure.

FIGS. 7A and 7B are cross-sectional side and front views, respectively,of a bottom clamping arm of the patellar clamp in accordance with someembodiments of the present disclosure taken along lines A-A and B-B inFIG. 6.

FIGS. 8A, 8B, 8C, and 8D are bottom, side, rear, and cross-sectionalside profile views, respectively, of a reamer guide of the patellarclamp in accordance with some embodiments of the present disclosure.

FIG. 9 is an isometric view of the top of a reamer guide of the patellarclamp in accordance with some embodiments of the present disclosure.

FIG. 10 is an isometric view of the bottom of a reamer guide of thepatellar clamp in accordance with some embodiments of the presentdisclosure.

FIG. 11 is a cross-sectional front view of a patellar clamp,specifically the reamer guide and bottom clamping arm, engaged about thepatella during reaming in accordance with some embodiments of thepresent disclosure.

DETAILED DESCRIPTION

With reference to the Figures, where like elements have been given likenumerical designations to facilitate an understanding of the drawings,the various embodiments of a patellar clamp and associated system andmethod for using the clamp are described. The figures are not drawn toscale.

The following description is provided as an enabling teaching of arepresentative set of examples. Those skilled in the art will recognizethat many changes can be made to the embodiments described herein whilestill obtaining beneficial results. It will also be apparent that someof the desired benefits discussed below can be obtained by selectingsome of the features or steps discussed herein without utilizing otherfeatures or steps. Accordingly, those who work in the art will recognizethat many modifications and adaptations, as well as subsets of thefeatures and steps described herein are possible and can even bedesirable in certain circumstances. Thus, the following description isprovided as illustrative and is not limiting.

This description of illustrative embodiments is intended to be read inconnection with the accompanying drawings, which are to be consideredpart of the entire written description. In the description ofembodiments disclosed herein, any reference to direction or orientationis merely intended for convenience of description and is not intended inany way to limit the scope of the present invention. Relative terms suchas “lower,” “upper,” “horizontal,” “vertical,”, “above,” “below,” “up,”“down,” “top” and “bottom” as well as derivative thereof (e.g.,“horizontally,” “downwardly,” “upwardly,” etc.) should be construed torefer to the orientation as then described or as shown in the drawingunder discussion. These relative terms are for convenience ofdescription only and do not require that the apparatus be constructed oroperated in a particular orientation. Terms such as “attached,”“affixed,” “coupled”, “connected,” and “interconnected,” refer to arelationship wherein structures are secured or attached to one anothereither directly or indirectly through intervening structures, as well asboth movable or rigid attachments or relationships, unless expresslydescribed otherwise. Accordingly, the disclosure expressly should not belimited to such embodiments illustrating some possible non-limitingcombination of features that may exist alone or in other combinations offeatures.

FIG. 1 is a cutaway view of the typical anatomy of the knee, providedfor a general understanding of the region in which the presentdisclosure is to be used. Of interest to the present disclosure, apatella 2 is held in place over the knee joint by a quadriceps tendon 4and a patellar tendon 6. Quadriceps tendon 4 links the patella 2 withthe femur 8, while patellar tendon 6 links the patella 2 with the tibia9.

FIGS. 2-5 provide views of an exemplary embodiment of the presentdisclosure. FIG. 2 is an isometric view of a patellar clamp 100 of anexemplary embodiment of the present disclosure. FIG. 3 is an isometricview of a patellar clamp 100 with reamer guide 150 removed in anexemplary embodiment of the present disclosure. FIGS. 4A, 4B, and 4C arefront, side, and bottom profile views of a patellar clamp 100 of anexemplary embodiment of the present disclosure. FIG. 5 is across-sectional side view of the patellar clamp 100 of an exemplaryembodiment of the present disclosure taken along line A-A of FIG. 4.

Referring now to FIGS. 2-5, patellar clamp 100 includes a lower handle102 and upper handle 104, pivotally coupled together with a compressionleaf spring 106 biasing the handles apart. The distal end 101 of upperhandle 104 is pivotally coupled to bottom clamping arm 130. Upper handle104 further includes a toothed ratchet bar 108 which is engageable witha pawl 111 disposed on a locking lever 110 pivotally mounted on lowerhandle 102 for locking the handle into position when the desiredclamping pressure on the patella 2 is achieved.

The distal end 103 of lower handle 102 is pivotally coupled to a slidingtop clamp arm 140 which is slidable up and down on a reamer supportcolumn 132 of bottom clamping arm 130 configured to mount the outriggerof a reamer assembly (not shown) thereto. Suitable reamers and reamerassemblies useable with patellar clamp 100 include the Advance® PatellarReaming System commercially available from Wright Medical Technology,Inc. of Arlington, Tenn. Embodiments of top clamp arm 140 include anopening 121 for receiving reamer support column 132 completelytherethrough as shown in FIGS. 2 and 3.

Top clamp arm 140 includes a reamer guide mounting bracket 142configured to detachably receive and mount thereto a reamer guide 150shown in FIG. 2. With additional reference to FIGS. 3-5, mountingbracket 142 includes a frontal opening 146 communicating with aninternal cavity 148 configured to insert a portion of a reamer guidemounting stem 152 therein to secure the reamer guide 150 (see also FIGS.8-10). A spring-loaded plunger assembly 144 comprised of an elongatedplunger 145 having an operating button 141 and spring 143 as furtherdescribed herein is included with the mounting bracket assembly (seealso FIGS. 4 and 5). Plunger 145 is cylindrically shaped in someembodiments including a stem extending through a top opening in themounting bracket 142 into cavity 148 and including a diametricallyenlarged portion 147 configured to engage a complementary sized andconfigured socket 156 disposed in the stem 152 of reamer guide 150. Theplunger assembly allows the reamer guide to be detachably mounted to thepatellar clamp 100, as further described herein.

Top clamp arm 140 further includes a U-shaped rear bifurcated portioncomprised of a pair of spaced-apart legs 149 which extend around aportion of upper handle 104 received therebetween as shown in FIGS. 2-5.The legs 149 can include elongated slots 120 configured to slidablyreceive a dowel pin 122 having one end affixed to upper handle 104 forguiding movement and supporting sliding top clamp arm 140.

FIGS. 6 and 7 are directed to bottom clamping arm 130. FIGS. 6A, 6B, and6C are side, top, and rear profile views, respectively, of a bottomclamping arm 130 of the patellar clamp 100 in accordance with someembodiments of the present disclosure. FIGS. 7A and 7B arecross-sectional side and front views, respectively, of a bottom clampingarm 130 of the patellar clamp 100 in accordance with some embodiments ofthe present disclosure taken along lines A-A and B-B in FIG. 6.

Referring now to FIGS. 2-7, bottom clamping arm 130 includes a patellasupport base 134 and reamer support column 132. In some embodiments,patella support base 134 and reamer support column 132 are formed asintegral unitary structural components of bottom clamping arm 130.Reamer support column 132 is disposed perpendicular to patella supportbase 134 and is vertically elongated. Reamer support column 132 includesan elongated slot 131 which receives a dowel pin 136 therethrough (seeFIG. 5) for sliding upward and downward movement. Dowel pin 136 movablycouples lower arm 102 and top clamp arm 140 together at the column. Inoperation, opening and closing the lower handle 102 and upper handle 104correspondingly moves top clamp arm 140 up and down with respect toreamer support column 132 and patella support base 134 to providepatella clamping action.

With continuing reference to FIGS. 2-7, patella support base 134 ofbottom clamping arm 130 is horizontally elongated and includes aproximal portion 135 adjoining reamer support column 132 and adiametrically enlarged distal patella support portion 133 (hereafterdistal portion 133) configured to engage the patellar bone. In someembodiments, distal portion 133 is disposed perpendicular or 90 degreesto reamer support column 132.

In some embodiments, distal portion 133 is substantially circular inconfiguration when viewed from the top (see FIG. 6B). Distal portion 133of bottom clamping arm 130 includes a substantially planar top surface160 including a concave shaped gripping region 164 centrally located onthe top surface 160. The gripping region 164 can be contoured to matchthe prominence or convex shape of the anterior side of the patella 2 toimprove clamping and immobilizing the patella 2 during reaming. In someembodiments, gripping region 164 includes a textured surface treatmentconfigured to increase frictional grip between the gripping region 164and patella 2. In some embodiments, the textured surface can includediamond-shaped teeth to positively grip the anterior surface of thepatella 2 and resist twisting of the patella 2 during reaming of theopposite posterior surface of the patella 2. In one representativeembodiment, the textured surface can be 0.060- to 0.080-inch crosspattern diamond-shaped teeth. Other suitable textured surfaceconfigurations and gripping features are contemplated and can be used.The concave gripping region 164 can cover substantially the majority,and in some embodiments substantially the entire top surface 160 of theenlarged circular distal portion 133 of the bottom clamping arm 130. Asopposed to long spikes used heretofore in some embodiments, the diamondpatterned gripping surface improves grip and stability of the patella 2during reaming and is less intrusive on the patellar bone.

With continuing reference to FIGS. 2-7, enlarged distal portion 133 ofbottom clamping arm 130 includes a pair of diametrically opposed andelongated flanges 162 configured to grasp the quadriceps tendon 4 andpatellar tendon 6 on opposing sides of the patella 2 (see, e.g., FIG.1). In some embodiments, flanges 162 are arranged 180 degrees apart tocomplement the same arrangement of the quadriceps tendon 4 and patellartendon 6 with respect to the patella 2 (see FIG. 1). In some embodimentsflanges 162 extend radially outwards from distal portion 133 in adirection perpendicular to lower handle 102 and upper handle 104. Insome embodiments, as best shown in FIG. 6, flanges 162 can include asubstantially flat side distal edge 166 and an opposing arcuate proximalside 168 closest to lower handle 102 and upper handle 104 to conform tothe shape of the tendons when twisting during eversion and rotation ofthe patella 2 upon clamping to minimize trauma to the tendons.

FIGS. 8-10 are directed to reaming guide 150. FIGS. 8A, 8B, 8C, and 8Dare bottom, rear, side, and cross-sectional side profile views,respectively of a reamer guide 150 of the patellar clamp 100 inaccordance with some embodiments of the present disclosure. FIG. 9 is anisometric view of the top of a reamer guide 150 of the patellar clamp100 in accordance with some embodiments of the present disclosure. FIG.10 is an isometric view of the bottom of a reamer guide 150 of thepatellar clamp 100 in accordance with some embodiments of the presentdisclosure. FIG. 2 additionally shows reaming guide 150 connected to thepatellar clamp 100.

Reaming guide 150 is generally tubular and hollow shaped defining anannular sidewall 158 extending between annular top edge 151 and annularbottom edge 153. In some embodiments, bottom edge 153 engages thequadriceps tendon 4 and patellar tendon 6 and is a relatively smooth,plain surface without textures or teeth. Sidewall 158 defines a centralpassageway 154 that extends completely through the reaming guide 150(see FIGS. 8-10), and which is sized and configured to rotatably receivea reamer (not shown) therein for milling and/or planing the posteriorsurface of the patella 2.

Reaming guide 150 further includes a pair of diametrically opposed andelongated flanges 155 configured to grasp the quadriceps tendon 4 andpatellar tendon 6 on opposing sides of the patella 2 (see, e.g., FIG.1). When the reaming guide 150 is mounted to patellar clamp 100, asshown in FIG. 2, flanges 155 extend radially outwards from sidewall 158in a direction perpendicular to the lower handle 102 and upper handle104. In some embodiments, flanges 155 are arranged 180 degrees apart tocomplement the same arrangement of the quadriceps tendon 4 and patellartendon 6 with respect to the patella 2 (see FIG. 1). In someembodiments, flanges 155 are disposed adjacent to bottom edge 153thereby being positioned to engage the tendons. Flanges 155 arepositioned for vertical alignment with flanges 162 of bottom clampingarm 130 to provide clamping action when combined for grasping andholding the quadriceps tendon 4 and patellar tendon 6 during the reamingoperation. Flanges 155 and 162 will be disposed on the top and bottomsides of the tendons, respectively, when clamped by patellar clamp 100.In various embodiments, flanges 155 and 162 can have substantially equalor different total radial widths measured from end-to-end of eachflange. In some embodiments, flanges 162 can have a greater radial widththan flanges 155.

To eliminate a narrow bottom edge for portions of sidewall 158 of thereamer guide 150 that can engage part of the quadriceps tendon 4 andpatellar tendon 6, some embodiments of reamer guide 150 include aradially broadened bottom rim 157 disposed along bottom edge 153 (seeFIGS. 8-10), thereby providing a generally flat bottom annular surfaceon guide 150 if the tendons might be engaged during clamping of patellaclamp 100 onto the patella 2.

Referring primarily to FIGS. 8-10, reaming guide 150 includes a mountingstem 152 protruding radially outwards from a rear portion of sidewalls158. Stem 152 includes a rearwardly open slot 159 and socket 156configured to engage diametrically enlarged portion 147 of plunger 145.In some embodiments, socket 156 is downwardly open and communicates withslot 159 that receives the stem of plunger 145 therein. To mount thereamer guide 150 to mounting bracket 142 on top clamp arm 140, thespring-loaded plunger is first depressed to lower enlarged portion 147.The mounting stem 152 of reamer guide 150 is next inserted rearwardlyinto frontal opening 146 of the bracket, and the plunger is thenreleased which seats the enlarged portion 147 in socket 156, therebylocking reamer guide 150 into the mounting bracket 142.

In some embodiments, reamer guide 150 has a diameter large enough toexpose a maximum surface area of the posterior articular surface of thepatella to be resurfaced. A reamer guide 150 of sufficient diameteravoids the need to unclamp, reposition, re-clamp, and ream peripheralportions of the posterior surface which were occluded by the reamerguide during an initial reaming operation. Advantageously, this is madepossible by the configuration and size selected for the reamer guide 150and smooth bottom edge 153 thereon giving the patellar clamp 100 theability to clamp the quadriceps tendon 4 and patellar tendon 6 primarilywith flanges 155 and 162 to support and stabilize the patella againsttorsion during reaming in lieu of gripping the posterior surface of thepatellar bone to be resurfaced with teeth or other similar-shapedgripping features on the bottom edge of the reamer guide 150. In someembodiments, a diameter for reamer guide 150 can be selected that isslightly larger than the outer periphery of the posterior surface areaof the patella 2 to be reamed and resurfaced for receiving a prostheticimplant. The reamer guide 150 can have a diameter that is at leastlarger than the area of the patella 2 lying between the quadricepstendon 4 and patellar tendon 6 (see FIG. 1) to be resurfaced. In someembodiments, a patellar clamp 100 kit has reamer guides 150 of differentdiameters so a surgeon can select the appropriately sized reamer guide150 to match the size of the patient's patella 2 and achieve theabove-mentioned advantages when clamping the quadriceps tendon 4 andpatellar tendon 6 using the reamer guide 150.

An exemplary method for clamping a patella 2 using patellar clamp 100will now be briefly described. If a patellar clamp 100 kit is providedwith a plurality of different diameter reamer guides 150, the surgeonfirst selects the appropriately sized reamer guide 150 to allow a singleclamping and reaming step to be used for resurfacing a predeterminedportion of the posterior articular surface of the patella 2. In someembodiments, the predetermined portion of the posterior articularsurface of the patella 2 is the entire posterior articular surface ofthe patella 2 desired. This reamer guide 150 can have a diameter atleast the same as or slightly larger than the outer periphery ordiameter of the bone region to be resurfaced. The surgeon mounts theselected reamer guide 150 to patellar clamp 100 in the manner alreadydescribed using the spring loaded plunger 145 resulting in aconfiguration of patellar clamp 100 shown in FIG. 2.

Patellar clamp 100 is adjusted as needed to an open position as shown inFIG. 2 with distal portion 133 of bottom clamping arm 130 spaced apartfrom reamer guide 150 by a distance sufficient to insert the patella 2therebetween. The everted and rotated patella 2 is next positionedbetween bottom clamping arm 130 and reamer guide 150. The quadricepstendon 4 and patellar tendon 6 will become twisted to a certain degreeby the eversion depending on the degree of inverting the patella 2 thatis used by the surgeon. The convex surface of the anterior surface ofthe patella 2 is positioned in alignment with and can be partially orfully engaged with concave-shaped gripping region 164 of bottom clampingarm 130. In some embodiments, concave-shaped gripping region 164 caninclude a textured gripping surface treatment such as diamond-shapedteeth to enhance the frictional grip on the patellar bone. At the sametime, the quadriceps tendon 4 and patellar tendon 6 (see FIG. 1) areinserted and positioned between the mating pairs of flanges 155 and 162.

Lower handle 102 and upper handle 104 are next squeezed together in aclosing direction by the user which is translated into a correspondingclosing and clamping action of the bottom clamping arm 130 and reamerguide 150 attached to top clamp arm 140. Reamer guide 150 is loweredinto engagement with substantially only the quadriceps tendon 4 andpatellar tendon 6, with the smooth bottom edge 153 and flanges 155 ofthe guide engaging the tendons instead of the patella 2 bone. This isachieved by selecting a reamer guide 150 with a diameter larger than theposterior exposed patella 2 bone areas between the points on the bonewhere the tendons are attached (see FIG. 1). The clamping action grabsand holds the tendons firmly between the mating pairs of flanges 155 and162 on the reamer guide 150 and bottom clamping arm 130. In someinstances, since the geometry of the patella 2 is not perfectly circularbut slightly irregular with somewhat triangular-circular combination ofshapes (see FIG. 1), engagement of the reamer guide 150 with a minorperipheral portion of bone on posterior surface of the patella 2 notlying between the quadriceps tendon 4 and patellar tendon 6 (e.g.peripheral medial and/or lateral edges) can occur. However, the primaryclamping forces for holding and immobilizing the patella 2 duringreaming of the bone are between the reamer guide 150 and tendons inpreferred embodiments.

A fully clamped patella 2 and tendons engaged by flanges 155 and 162 areshown in the cross-sectional front view of FIG. 11. Once the patella 2is clamped, the position of lower handle 102, upper handle 104, andpatellar clamp 100 can be locked by engaging locking lever 110 withratchet bar 108. The reamer assembly (not shown) can then be mounted onpatellar clamp 100 (if not already done before) and the reamer (see FIG.11) positioned within reamer guide 150 to engage the patellar bone forresurfacing.

Once reaming is complete, the patellar clamp 100 can be removed byreversing the foregoing steps.

The components of patellar clamp 100 disclosed herein can be made of anysuitable surgically-approved materials amenable to sterilizationincluding metals, non-metals, and combinations thereof. In someembodiments, reamer guide 150 and bottom clamping arm 130 are made ofASTM A564-Type 630 martensitic precipitation hardened stainless steel.Other suitable materials can be used.

Advantages of the present embodiments of patellar clamp 100 according tothe present disclosure include the ability to ream and resurface theentire desired posterior articular surface of the patella 2 in a singleoperation without readjusting the position of the reamer guide 150 forperforming additional reaming steps around the peripheral surfaces ofthe patella 2. This is achieved in part by the mating flanges 155 and162 which grasp and clamp the quadriceps tendon 4 and patellar tendon 6to stabilize the reamer guide 150 during reaming allowing a largerdiameter reamer guide 150 and reamer cutting head to be used. Anadditional advantage of some embodiments of patellar clamp 100 is thatthe soft tissue of the tendons is protected from trauma by eliminatingthe need for grasping teeth on the reamer guide 150 and thereby allowingfor the provision of smooth surfaces on reamer guide 150 disclosedherein that engage the patella 2 and/or portions of the tendons.

In some embodiments, a clamping instrument is provided. The clampinginstrument includes a pair of handles movably coupled together; apatella support portion operatively connected to the pair of handles viaa bottom clamping arm and configured to engage a first side of apatella. The patella support portion included a first pair of flangeseach configured to engage a first and second tendon associated with thepatella. The clamping instrument also includes a reamer guide configuredto engage a second side of the patella. The reamer guide includes asecond pair of flanges each configured to engage said first and secondtendons associated with the patella. The clamping instrument isconfigured to operably engage the first and second tendons associatedwith the patella between the first and second pairs of flanges byapplication of a squeezing motion to the pair of handles to bring eachhandle toward the other.

In some embodiments, a system for clamping a patella is provided. Thesystem includes a patellar clamp comprising a pair of handles movablycoupled together, a patella support portion operatively connected to thepair of handles via a bottom clamping arm and configured to engage afirst side of a patella, the patella support portion including a firstpair of flanges each configured to engage a first and second tendonassociated with the patella and a plurality of reamer guides, eachreamer guide of said plurality having a different diameter than eachother reamer guide of said plurality to allow a user to select anappropriately-sized reamer guide, wherein each reamer guide isconfigured to engage a second side of the patella, each reamer guideincluding a second pair of flanges configured to engage said first andsecond tendons associated with the patella.

In some embodiments, a method of clamping a patella is provided. Themethod includes selecting, from a plurality of reamer guides, a reamerguide configured to enable reaming a predetermined portion of a patellarsurface. The selected reamer guide is configured with a first pair offlanges extending from the reamer guide. The method also includesattaching the selected reamer guide to a patellar clamp including a pairof handles and a bottom clamping arm with a patellar support portion anda second pair of flanges. The method includes placing the patellar clampin an open position, positioning an everted and rotated patella betweenthe selected and attached reamer guide and the patellar support portionof the bottom clamping arm, and squeezing the pair of handles togetherin a closing motion, causing the selected and attached reamer guide tolower toward the patella and the first pair of flanges and the secondpair of flanges to operably engage the quadriceps tendon and patellartendon.

While the foregoing description and drawings represent illustrativeembodiments of the present disclosure, it will be understood thatvarious additions, modifications and substitutions can be made thereinwithout departing from the spirit and scope and range of equivalents ofthe accompanying claims. In particular, it will be clear to thoseskilled in the art that the present invention can be embodied in otherforms, structures, arrangements, proportions, sizes, and with otherelements, materials, and components, without departing from the spiritor essential characteristics thereof. In addition, numerous variationsin the methods/processes. One skilled in the art will further appreciatethat the embodiments can be used with many modifications of structure,arrangement, proportions, sizes, materials, and components andotherwise, used in the practice of the disclosure, which areparticularly adapted to specific environments and operative requirementswithout departing from the principles described herein. The presentlydisclosed embodiments are therefore to be considered in all respects asillustrative and not restrictive. The appended claims should beconstrued broadly, to include other variants and embodiments of thedisclosure, which can be made by those skilled in the art withoutdeparting from the scope and range of equivalents.

What is claimed is:
 1. A clamping instrument configured to engage afirst and a second tendon associated with a patella of a patientcomprising: a pair of handles movably coupled together; a patellasupport portion operatively connected to the pair of handles via abottom clamping arm and configured to engage said patella, the patellasupport portion including a first pair of flanges each configured toengage said first and said second tendon associated with said patella;and a reamer guide configured to engage a side of said patella, thereamer guide including a second pair of flanges each configured toengage said first and second tendons associated with said patella;wherein the clamping instrument is configured to operably engage saidfirst and second tendons associated with said patella between the firstand second pairs of flanges by application of a squeezing motion to thepair of handles to bring each handle toward the other.
 2. The clampinginstrument of claim 1, wherein the patella support portion includes aconcave-shaped gripping region configured to engage a convex portion ofsaid patella.
 3. The clamping instrument of claim 2, wherein thegripping region includes a textured surface treatment configured to gripsaid patella.
 4. The clamping instrument of claim 1, wherein the tendonsare the quadriceps and patellar tendons.
 5. The clamping instrument ofclaim 1, wherein the reamer guide is detachably connected to theclamping instrument.
 6. The clamping instrument of claim 1, wherein saidpair of handles are biased apart by a compression leaf spring.
 7. Theclamping instrument of claim 1, further comprising a sliding top clamparm which is slidable up and down on a reamer support column of saidbottom clamping arm.
 8. The clamping instrument of claim 7, wherein saidsliding top clamp arm is pivotably coupled to a lower handle of saidpair of handles.
 9. A system for clamping a first and a second tendonassociated with a patella of a patient, comprising: a patellar clamp,comprising: a pair of handles movably coupled together; a patellasupport portion operatively connected to the pair of handles via abottom clamping arm and configured to engage of said patella, thepatella support portion including a first pair of flanges eachconfigured to engage said first and said second tendon associated withsaid patella; and a plurality of reamer guides, each reamer guide ofsaid plurality having a different diameter than each other reamer guideof said plurality, wherein each reamer guide is configured to engage asecond side of said patella, each reamer guide including a second pairof flanges configured to engage said first and second tendons associatedwith said patella.
 10. The system of claim 9, wherein each reamer guideof said plurality of reamer guides is detachably connectable to saidpatellar clamp via a reamer guide mounting bracket.
 11. The system ofclaim 10 wherein said reamer guide mounting bracket comprises: a frontalopening communicating with an internal cavity configured to receive aportion of a reamer guide mounting stem; and a spring-loaded plungerassembly having an elongated plunger with an operating button andspring.
 12. The system of claim 9, said patellar clamp furthercomprising a sliding top clamp arm which is slidable up and down on areamer support column of said bottom clamping arm.
 13. The system ofclaim 12 wherein said sliding top clamp arm is pivotably coupled to alower handle of said pair of handles.
 14. The system of claim 13 whereinthe patella support portion includes a concave-shaped gripping regionconfigured to engage a convex portion of said patella.
 15. The system ofclaim 14 wherein the gripping region includes a textured surfacetreatment configured to enhance gripping said patella.